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East Champaran, Bihar, September 6, 2007: At a Nutritional Rehabilitation Centre in East Champaran, little Azad clings to his mother Fatima and cries every time she tries to move. Azad is three years
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Azad is comforted by his mother at the Nutritional Rehabilitation Centre

By Robin Giri

East Champaran, Bihar, September 6, 2007: At a Nutritional Rehabilitation Centre (NRC) in East Champaran, little Azad clings to his mother Fatima and cries every time she tries to move. Azad is three years old, but one can never tell by his emaciated body, his features topped by brittle, light coloured hair – signs of malnourishment.

A little further away, another mother stares vacantly and cradles her frail, waif-like child named Renu, who is supposedly two but wouldn’t pass for more than six months.

It is hard to believe that an astonishing 46.3 per cent of all children under the age of three in India are malnourished. In Bihar the figures are an alarming 58 per cent, with 4% of the children like Azad above, being classified under Severe Acute Malnutrition (SAM).

More than a month after the flooding began in Bihar millions of people in more than 20 districts continue to be affected. The overwhelming majority rely on the food items distributed by the Government – which in many cases have been delayed because of roads still submerged or washed away. And this has worsened the health and nutritional status of children and women in Bihar.

“In the beginning it was imminent that these children and mothers be provided with an additional supplementary diet. At the same time, the needs of those children who were suffering from severe acute malnutrition (SAM) couldn’t be addressed just by food and we had to have something more comprehensive in place,” says Bijaya Rajbhandari, UNICEF’s Representative in Bihar.

For the supplementary nutritional programme, UNICEF joined hands with local women’s organisations like the Mahila Samakhya and other NGOs – to provide nutritious meals that could meet dietary requirements for children under 5 years of age, and pregnant and lactating mothers.

Beginning in the third week of August, this meal of khichdi– gruel of rice, lentils, and soy, is being provided to 22,000 children and 5,000 pregnant and lactating mothers, from 194 kitchens in the eight most affected districts.

First Nutritional Rehabilitation Centres to be set up in Bihar
To attend to the more urgent needs of severely malnourished children such as proper feeding and prompt medical treatment, UNICEF, in partnership with State Health Society, Bihar, has established two Nutritional Rehabilitation Centres (NRCs) in the state.

Children receiving the mid-day meal provided by UNICEF, Muzaffarpur, Bihar.

With funding and technical assistance from UNICEF, these NRCs, the first in the state, have been set up at district hospital in East Champaran and at the Referral Hospital in Sarraiya block Muzaffarpur – two of the most flood-affected districts.

The two NRCs, which have 29 beds, is a residential programme for mothers and their severely malnourished children for two weeks. Here the children are fed a special diet, weighed and monitored daily, and have their blood and urine tested for any childhood illnesses. Till date, 29 children are being cared for at the NRCs.

“Every child that is admitted here receives comprehensive medical care,” says Deepali, a UNICEF Nutritional Consultant in East Champaran. Any child that requires medical care that cannot be administered at the NRC is referred to the district hospital immediately.

Each NRC is staffed by a nurse, a Feeding Demonstrator, a cook, two helpers and a paediatrician who checks the children twice daily for their nutritional and medical needs.

Shweta Gautam is the feeding demonstrator who monitors the dietary needs of every child. “I was really scared when Azad was first brought in but within a week he has gained about 200 gms body weight and will begin a normal diet from today,” she says.

One of the major priorities of the NRC is to counsel mothers on how to prepare nutritious food for their children from what is available to them. The other is to dispel the stereotypes and myths about their children’s dietary needs, like Renu’s mother who was only breast-feeding her for two years.

“The idea is that these mothers leave the NRC with enough knowledge that will keep themselves and their babies safe and healthy,” says Shweta.

UNICEF Bihar is hoping that the introduction of the NRCs in this post-flood situation will urge the Government of Bihar to set up many more similar facilities and eventually to bring NRCs into the mainstream.

The Government of India is also taking a proactive approach to combat this silent killer. In his Independence Day address, the Prime Minister of India, Manmohan Singh said malnutrition was a “matter of national shame.” He has called upon all state Governments and communities to work towards eradicating malnutrition within five years.